Conference Presentation

The following is a text version of the presentation given at the Conference on Timely Access To Health Care, held February 8-9, 2007 in Toronto, Ontario.

Enhancing Access by Bridging the Distance: The New Brunswick Telehealth Experience

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Presentation Outline

• The New Brunswick Context
• Challenges and Creativity
• NB- Early Innovator in Telehealth
• Telehealth Definition
• Telehealth in NB
• Vision
• Guiding Principles
  • Telehealth Infrastructure
  • DI Infrastructure
• Enhancing Access
• New Brunswick Heart Centre
• Clinical Issues Prompting System Changes
• Objectives for Telehealth Use
• Cardiac Triage - Teleconsultation
• Post Surgery - Hospital to Home Monitoring
• Results - Quality
• Results - Acceptability
• Overall Evaluation
• Testimonials
• Telehealth and the New Brunswick Heart Centre
• Outpatient Clinics
• Telehomecare EMPcare@home
• And there are many other examples...
• Nephrology
• Summary
• Telehealth, a NB success story as defined by...
• Success...as acknowledged by others

The New Brunswick Context

• New Brunswick is a rural province with a geographically dispersed population
• We are required by law to offer health services in two official languages
• Tertiary services are concentrated in NB's 3 largest cities in the south: Moncton, Saint John & Fredericton

Challenges and Creativity

NB - Early Innovator in Telehealth

"Imagination is more important than knowledge. knowledge."

Telehealth Definition

"The use of information and communication technology to deliver health services, expertise and information over distance."

Telehealth in NB

Bridging distances by bringing quality health services and information to all New Brunswickers.

Vision

Independent of the location of patient and providers, telehealth will:

• Empower consumers and communities
• Improve access to needed services and expert resources
• Decrease wait times for health services
• Maximize opportunities for self self-care and compliance to treatment plans
• Mobilize new opportunities for patients, families and communities to prevent illness and promote wellness

Guiding Principles

• Alignment with the provincial health plan
• Improve access/wait times
• Clinical programs, not technology, drive priorities
• Provides value for client, provider and funder
• Respect for preference of language, culture, location of service
• Integration with clinical programs & EHR
• Respect for privacy & confidentiality
• Ease of use
• Adopt standards of best practice

Telehealth Infrastructure

DI Infrastructure

Enhancing Access

"Taking the hype out of Telehealth and utilizing available technology, allows us as health care providers to seize opportunities to increase access to quality holistic health care. We are limited only by our imagination imagination".

Krisan Palmer, Manager, Telehealth Department, Atlantic Health Sciences Corporation

New Brunswick Heart Centre

• The New Brunswick Heart Centre (NBHC) provides tertiary cardiac care to the province of New Brunswick
• Initiated telehealth service in the 90s as a result of issues relating to access and continuity of care
• As a result of this and other program improvements, currently
  • 96% of all coronary artery bypass surgeries are completed within 182 days

Clinical Issues Prompting System Changes

Cardiac Triage

• No objective, systematic approach in referrals or prioritization
• Loss of patient data
• Inequities

Following surgery

• 32.3% reaccess rate to local emergency
• 54% of those readmitted
• No communication to the Heart Centre
• Inappropriate case management

Objectives for Telehealth Use

• Objective, systematic approach to cardiac triaging
• Increase access to specialized scarce resources and reduce wait times
• Increase quality and continuity of care
• Extend the hospital into the home
• Decrease reaccess, readmission rates
• Eliminate geography

Cardiac Triage - Teleconsultation

• Contact system through remote terminal at any time of day
• Data stored on server at the Heart Centre
• Maintain list of all patients and provide feedback to referring centres re: where patients are on the list
• Utilization of an acuity/priority scoring system to objectively rank patients for transfer

Post Surgery - Hospital to Home Monitoring

• Real-time interactive clinical monitoring system (ECG, NIBP,SP02)
• Fully interactive audio and video
• Wound Management
• Works on standard phone line (POTS)

 

 

 

Results - Quality

• Ease of access to expert advice improved quality of care, and reduced reaccess rates by study patients during immediate post discharge period
• Clinically valuable, treatment of symptoms before emergent

Results - Acceptability

• Patient satisfaction- 80 - 100%
• Clinician satisfaction- 80 - 100%
• Technology
  Performance 91- 100%
  Peripherals 92- 99%

Overall Evaluation

• Determined clinically equivalent
• Improved access/wait times
• Enhanced capacity
• Cost of access to care is significantly reduced for patients and their families

Testimonials

• "It is an excellent program, easy to use.We feel really secure knowing we are being monitored daily by our nurse. It lessens our fear of something happening." -patient
• "It's facilitates great collaboration with the specialists at the heart centre" - remote MD
• "You are angels in a suitcase!!" - patient

Telehealth and the New Brunswick Heart Centre

• An integral component of the New Brunswick Heart Center
• Teleconsultation and home monitoring are key components for appropriate access and wait times
• Home monitoring provides service to over 450 patients a year
• Has undergone planning for technology enhancement and incorporation of all information collected into the Region Region's Clinical information System

Outpatient Clinics

• Real-time interactive audio and video
• Data channel allows auscultation of heart and lung sounds
• Wound management
• Echocardiograms,
• X-rays

Telehomecare EMPcare@home

• Provincial Telehomecare demonstrator initiative
• New approach to care of patients with a chronic care disease
• 85% decrease in hospital admissions for patients
• 55% decrease in emergency room visits
• 96% -overall patient satisfaction with service
  95% - recommend to others
  93% - better knowledge of health condition

Overall, improved access to appropriate care when required resulted in enhanced patient outcomes, decreased utilization of hospital care and therefore enhanced capacity for hospital based services.

And there are many other examples examples...

• Telemental health - provision of emergency mental health services and consultation services in areas without this expertise. Increased access to specialty services and reduced wait times.
• Oncology services -provision of education and information from a provincial cancer centre to the northern regions. Increased access to specialty services and reduced wait times.

Nephrology

Satellite Dialysis Unit

• Access to EHR Physician order entry Review of diagnostics
• Wound Management Overall improved access to services and greatly reduced patient travel.

Summary

Telehealth can be a positive enabler for enhancing access, reducing wait times and increasing capacity when when....

• It is embedded in the model for service delivery
• It is program driven not technology driven
• There has been effective change management and support in place

Telehealth, a NB success story as defined by...

• Enhanced access
• Reduced wait times
• Increased capacity
• Patient and provider satisfaction
• Quality care/outcomes
• Patient efficacy/self management
• Knowledge transfer/education
• Patient support/holistic care
• Innovation/technology performance
• Cost
• Attitude changes
  - "Just the normal way we do business"

Success...as acknowledged by others